Health information sharing

A foundation for our future health care system

August 25, 2017

Contributed by: Heidi E. Fell, MD, CCFP, FCFP

Many of us have thought about health information sharing in terms of the referral/consultation pathway or in terms of our obligations to protect information under the Health Information Act, but have you thought about it as a core value of a high-functioning health care system?

What if every health care provider in the province had exactly the right information, exactly when it was needed? What if patients had the relevant information at their fingertips to share with their providers, in a format that was easy for everyone to digest and that patients could help update? What if patients could refer to it as needed to remind themselves of their role in their care, just as providers refer to past information to remember the details? How many lives could be saved? How many dollars? How much time?

The potential promise of information sharing is huge, and other areas of the world are beginning to leverage this environment to improve their health care systems, but although we in Alberta lead in areas such as Netcare, large gaps still exist in our information sharing abilities. These gaps leave patients at risk and consume large amounts of resources in terms of time and dollars due to delays, missing information and repetition of tests and information. For example, primary care physicians in several areas of the province still receive no notification that their patient was seen in an urgent care center or emergency room.

Starting late last year, I had the opportunity to participate in a working group that created a discussion paper Health Information Exchange: Engaging Providers in Health Care Innovation. Although initially leery of yet another committee, once we got going, it turned into a robust discussion among several stakeholders including the Alberta Medical Association (AMA), Alberta Health, College of Physicians & Surgeons of Alberta, Alberta Health Services, Alberta College of Pharmacists and University of Calgary. The discussion centered on the state of information exchange in Alberta and the need for an integrated health record for each patient. This does not mean a single software program, but a secure central place for information accessible to all who need access to it, including the patient.

Through this paper and an accompanying symposium in February, many topics were explored, including the substantial literature supporting an integrated health record and its benefits, potential challenges and mitigating strategies, and an action framework to move things along.

As your AMA representative, my key messages were these:

Physicians want to share data, but it needs to be clinically valuable and done with the full understanding and input of our patients.

The AMA wants/needs to be a key partner in these activities, as evidenced by the Amending Agreement and subsequent board and Representative Forum attention.

The challenging clinical environment must be recognized in that any tools must not impede the relationship with the patient (workflow); the wide variety of clinical and non-clinical competing priorities must be acknowledged and streamlined; and significant attention must be paid to change management, including financial cost to the provider.

I understand there are many remaining challenges and concerns about privacy, workload, information overload, EMR burnout, patient expectations and professional autonomy – to name but a few. At the end of the day, though, I felt for the first time that these challenges were acknowledged as real barriers that could be overcome with appropriate attention and that this attention would come over time.

While we are waiting for some of this background and technical work to be done, we can resolve some issues among ourselves by collegially working together to ensure we all have appropriate information to care for our patients. Here are some of my thoughts to get things started:

Copy the family doctor on a report to a fellow specialist, even though the family doctor wasn’t the referral source.

Take an extra minute to check that your referral or consult has all the necessary information (but not every lab result since the dawn of time).

Give the patient a copy of their cumulative profile so they have a list of their problems, meds, allergies and past medical history in case they ever need to go to emergency or obtain care while traveling.

I look forward to hearing more ideas about how we can shape the integrated health record together.